gnaar Posted August 30, 2014 Share Posted August 30, 2014 Hi there, I'm in my first job as a PA. I work in inpatient medicine and I've been in this job about 9 months. I've really liked it so far. I work with a lot of different doctors which can be challenging with different practice styles and different levels of autonomy the providers like me to have, but so far I have had no issues. Everyone says I do a great job and they're impressed with the quality of my work as a new PA. There is a doc I have been dreading to work with a bit. She has some eccentric ideas and her priorities don't seem to be to practice evidence based, practice-standard type medicine. In any event, I was assigned to work with her this week and I tried to make the best of it and be professional and bite my tongue if needed. In my practice, we are assigned 6-12 patients total daily and work with 2-4 different docs at a time, so I had a few patients with her. We spoke briefly in the mornings about our patients. The issues began when she had different ideas about management and was pushing me to discharge patients early on in the day. This came in the form of text messages on my personal cell phone. We have an old paging system that can send text pages as well but many of us don't use it frequently as it's often down, so it's not unusual around here to use our own cell phones. I briefly texted back my rationale for waiting until the afternoon because I was worried about the patient's stability and there were some placement issues that would hold them back until at least the afternoon. I believe she saw this as a challenge to her plan or authority and it has been all downhill from there. Since then, every day I have been getting ruder and more upsetting texts from her, questioning my decision making that to me and the multitude of other providers I've worked with seems pretty sound. She is telling me to code and charge for things that clearly would not be correct. She is questioning why I don't have all my patients seen an hour before my shift ends (because I see and chart immediately and therefore rarely finish early), and telling me I need better time management. She knew I was swamped with a discharge at one point when another came up unexpected and needed to be ready in 30 minutes, and she was free (literally sitting in her office doing nothing) and offered to "do the discharge for me." I accepted and thanked her, only to be texted later that I needed to see the patient as well because she wasn't willing to document an exam or ROS. I was flabbergasted, and texted "I'm still finishing this other dc, I'll get there as soon as I can." To which she replied "You have 19 minutes." I have never felt so micromanaged and unappreciated. Typically I welcome constructive criticism, especially from a respected colleague, but this doc I feel is dangerous with patients and is the last person I want to be taking such rude comments from. I honestly never want to work with her again. I have heard advice that it's not wise to refuse to work with someone so early on in my career. I have saved all the rude texts and am setting up a meeting with my supervising physician, who thankfully is wonderful and I really respect her. My questions are, how would the more seasoned PAs out there handle this situation? Is it reasonable to professionally decline to work with someone like this? I do consider many of the text messages to be harassment and intimidation, would you go to HR separately with something like this? And for what it's worth, many of the other NPs/PAs I work with are starting to experience similar issues with this doc, so I think this is something against APCs as a whole, perhaps me particularly because I am so new and she thinks she can flex her muscle and bend me to her will... Any advice is appreciated, thank you! Link to comment Share on other sites More sharing options...
Timon Posted August 30, 2014 Share Posted August 30, 2014 I'm sorry that you are having this issue. I'm not a practicing PA but I have managed a staff of over 120 people and this issue is not something that is unique to healthcare. The key is to document everything first. Take a moment and write everything down, take screen shots of your texts messages and start building a history of all of the events that lead to this point. You're doing the correct thing by going to your supervisor and discussing with them what is going on. Don't expect them to solve it. Most likely you'll end up having to address this directly with the offending physician. I would listen to the advice your supervisor says about how to address this issue with this physician and if this continues or gets worse I would have a sit down with the offending physician that is micromanaging you. You definitely need to clear the air with this person as I'm sure there is a complete misunderstanding of what is going on. On one end there is productivity and on the other end there is patient safety. It seems that both of you are on opposite ends of this spectrum. According to your accounts, her actions are clearly vindictive and if not, retaliating towards your challenging her. But I'm only hearing your side of the story. You should seek out her perspective as you cannot assume that she is being vindictive towards you. You need to address the issue with her, tell her what your concerns are, find out what her concerns are, come to a mutual agreement and implement that plan. Later you need to follow-up and make sure that plan is working with her. If you do not feel comfortable one on one the offending physician, then schedule a conference with either your supervising physician or a representative from HR as a 3rd party mediator. If it continues from there, because you've kept documenting everything that has happened, make a formal complaint with human resources. The point being trying to work it out before it gets escalated and bringing the appropriate people in to help you manage this issue. I wish you the best of luck. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 30, 2014 Share Posted August 30, 2014 My opinion, and maybe it's because I'm in a ****** mood this morning for an unknown reason, but if you're comfortable in what you're doing as being the right decision, and especially if this individual is known for being a PITA and others are reinforcing your decision-making, then I'd blow her off. If she is only one of several SPs that you work for and she isn't the primary, nor the group boss, then she can do it herself. After my recent time off, and maybe it's because I'm where I'm at with regard to the timing of my career, I've come to a surprising realization that I'm not intimidated by the SPs, even when they are all associated with a very well respected medical school. Why? Because I realize that I'm now comfortable in my own skin and my decision-making, and I've also come to realize that there is more than one way to do things (this we all know even before graduation, I hope). For grins this week, just to get a feel for those that I'm now working under, I made it a point to raise some questions just to see what type of response I would get with regard to specific diseases/treatment options (ex.-diabetic on metformin/statin and which LRI abx. to use if PCN allergic since either the macrolides or FQ's could have an impact on current meds. and lead to complications). In this case I got different answers from several SPs who were present in the conference room simultaneously. Information filed away for future usage. I did make a point of expressing my thought process so that they could see how I would have arrived at the question at hand and thus hopefully provide them some reassurance that I knew what I was talking about since I don't go and present cases to them (new kid on block over the past week or so). I figure if they have an issue, whatever it may be, they'll find a way of letting me know. Getting more specific for your situation, I had a specialist (spine) when I first got out of school (mid-20's) that was part of the group and infrequently I had to interact with him, both in the office as well as the OR. For whatever the reason he just didn't seem to care for me and I was always intimidated by him. Looking back now with my own degree of self-assurance, he was just a jackass, and was frankly the worst surgeon of the three primary partners. I now realize that not being his favorite shouldn't have impacted me in the least. As long as the work got done correctly, or if a mistake was made that it was rectified in a timely manner, that is all that should matter. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 30, 2014 Moderator Share Posted August 30, 2014 tough spot if you were a seasoned PA I would say challenger her on it - stand up for yourself - don't get bulled over - even to the point of calling her on a team work approach.... BUT As a new grad PA this is likely not going to go over well, and you likely don't know enough to stand toe-to-toe with and attending..... so - involve you SP, and HR - explain that you are doing your best to learn, that everyone learns differently, but this one doc just seems to have a personal issue with you. You really should not decline to work with her, but certainly do not do anything to help her, or move her day along. Sort of the passive aggressive route, and she will likely realize one of two things 1) you are valuable and she should be nice or 2) she can do it herself...... I would keep a VERY DETAILED paper trail - HR always wants specifics so they can go back and figure it out..... so make a notebook , take notes on the happenings and try very hard to take UNBIASED notes - so that you can be accepted as the truth teller and not the one that stretches the truth above all - put on your rain coat, and deal with her..... let it roll off, realize she might just be a jerk and no matter what you do she might be mean to you.... heck some people are just not nice...... if you are doing a good job just don't worry about her..... Link to comment Share on other sites More sharing options...
UGoLong Posted August 30, 2014 Share Posted August 30, 2014 Learn what you can and try to ignore the rest. Stand up for yourself, regardless of where you are in life; bullies generally can't deal with that. Don't be rude but, if you act like a doormat, you will get covered in shoeprints. It is rare that the powers-that-be will step in and fix things for you. After all, if that weren't so, the bullies would be all gone by now. If you can't finesse the situation or get any help in getting you scheduled with other SPs -- and it greatly impacts your ability to work there -- then it's time to start looking for a new place. Life is too short to be dragged down by energy vampires. Link to comment Share on other sites More sharing options...
gbrothers98 Posted August 31, 2014 Share Posted August 31, 2014 This SP is pushing your buttons and thinks they can get away with it in the name of productivity. Small people like this usually get what is coming to them. I usually ignore individuals such as this. If you know your job and are doing what you are supposed to, their input is not necessary. Her repeated escalating texts indicates she is ready to cross a line.. Sounds like she may be borderline if she likes to not let things go. I have much anecdotal experience with medical personnel with personality disorders that disrupt the work environment. I would take the texts to your SP and request that you dont work with her anymore, that she is disruptive. Smile and move on. You will get a lot of insight into what kind of place you work at based upon how this is handled. There should be a disruptive physician policy at your facility. You can be held responsible to this policy and so will she. Good luck, this too shall pass. G Brothers PA-C Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted August 31, 2014 Share Posted August 31, 2014 Sounds like "Jo" from "The House of God". Buff and polish the chart for the SP but do what is in the best interest of the patient. I am a firm believer that less is better in the majority of cases (also from THOG). The fat man is a man of wisdom, even many decades later. Link to comment Share on other sites More sharing options...
KMD16 Posted September 1, 2014 Share Posted September 1, 2014 This issues need to be address immediately. You're been bullied. I've seen this many times. This particular attending smell fresh blood in the water. Go in humble. Weigh the bridges first. Do not burn your bridges. Trust no body! You may think Mr. A is on your side. We all want to keep our job and do not want to be involve in work related matter. There is politics in medicine. Ask yourself, who's who in your department? Address this cautiously. Have a one-on-one with your SP (on paper). Then, make your own assessment, whether to pursue it further or let it go. Keep in mind, you can't win. Your the new kids on the block. The outcome might be unfavorable even if you're right. I wish you the best. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 1, 2014 Moderator Share Posted September 1, 2014 Sounds like "Jo" from "The House of God". Buff and polish the chart for the SP but do what is in the best interest of the patient. I am a firm believer that less is better in the majority of cases (also from THOG). The fat man is a man of wisdom, even many decades later. they can always hurt you more....but they can't stop the clock..... Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 1, 2014 Moderator Share Posted September 1, 2014 Not a PA yet either, but I will offer my experience from lots of years in healthcare: I would see if you could get out from working with her and show all documentation for that. Many times at work I've run into people like this. Always assumed that I could just do better or adjust the interaction and we'd all get along. This has always ended badly for me. Now it hasn't happened again for me to put it into practice but I've resolved to not tolerate bullies. Like ugolong said, life's too short Link to comment Share on other sites More sharing options...
gnaar Posted September 2, 2014 Author Share Posted September 2, 2014 Thank you all so much for your input! I did print out all of the texts and made synopses of the situations to share with my supervising. We had a meeting recently, myself the rude unsavory doc, and my supervising. Thankfully one of the reasons I chose my job was because my supervising seemed very thoughtful and genuine and while she had to remain neutral during the meeting, she did stick up for my reasoning quite a bit and later thanked me for sticking up for myself during the meeting, too. It seems the rude doc has been doing herself in for some time with her other issues so hopefully I won't have to work with her much more, but if I do I will keenly take the advice of a paper trail and documentation.Very interesting about the personality disorders- several other members of my team have had encounters and have been wondering the same thing (docs and APCs alike). Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 2, 2014 Share Posted September 2, 2014 I'm telling you it's "Jo" from The House of God, reincarnated (especially if she's single! Glad you got it worked out. Link to comment Share on other sites More sharing options...
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